Provider Demographics
NPI:1720785397
Name:ARNOLD, CRYSTAL M (RN, CASAC II)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:RN, CASAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3812
Mailing Address - Country:US
Mailing Address - Phone:315-342-4489
Mailing Address - Fax:315-343-3281
Practice Address - Street 1:283 W 2ND ST # 200
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3812
Practice Address - Country:US
Practice Address - Phone:315-342-4489
Practice Address - Fax:315-343-3281
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY684463163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)